Low-dose Clonidine and Neostigmine Prolong the Duration of Intrathecal Bupivacaine–Fentanyl for Labor Analgesia

2000 ◽  
Vol 92 (2) ◽  
pp. 361-361 ◽  
Author(s):  
Medge D. Owen ◽  
Özer Özsaraç ◽  
Şükran Şahin ◽  
Nesimi Uçkunkaya ◽  
Nuray Kaplan ◽  
...  
Keyword(s):  
Side Effects ◽  
Low Dose ◽  
Fetal Heart ◽  
Vital Signs ◽  
Labor Analgesia ◽  
Pain Scores ◽  
Active Labor ◽  
Effective Pain Relief ◽  
Spinal Epidural ◽  
To Receive

Background Intrathecal (IT) opioid and local anesthetic combinations are popular for labor analgesia because of rapid, effective pain relief, but the duration of analgesia is limited. This study was undertaken to determine whether the addition of clonidine and neostigmine to IT bupivacaine-fentanyl would increase the duration of analgesia without increasing side effects for patients in labor. Methods Forty-five healthy parturients in active labor were randomized to receive a 2-ml IT dose of one of the following dextrose-containing solutions using the combined spinal-epidural technique: (1) bupivacaine 2.5 mg and fentanyl 25 microg (BF); (2) BF plus clonidine 30 microg (BFC); or (3) BFC plus neostigmine 10 microg (BFCN). Pain, sensory levels, motor block, side effects, maternal vital signs, and fetal heart rate were systematically assessed. Results Patients administered BFCN had significantly longer analgesia (165+/-32 min) than those who received BF (90+/-21 min; P<0.001) or BFC (123+/-21 min; P<0.001). Pain scores, block characteristics, maternal vital signs, Apgar scores, maternal satisfaction, and side effects were similar among groups except for nausea, which was significantly greater in the BFCN group (P<0.05 as compared with BFC). Conclusions The addition of clonidine and neostigmine significantly increased the duration of analgesia from IT bupivacaine-fentanyl during labor, but neostigmine caused more nausea. Although serious side effects were not observed in this study, safety must be further addressed before the routine use of multiple IT drugs is advocated.

The Dose-Response Relation of Intrathecal Fentanyl for Labor Analgesia 

1998 ◽  
Vol 88 (2) ◽  
pp. 355-361 ◽  
Author(s):  
Craig M. Palmer ◽  
Randall C. Cork ◽  
Richard Hays ◽  
Gretchen Van Maren ◽  
Diane Alves
Keyword(s):  
Blood Pressure ◽  
Dose Response ◽  
Fetal Heart ◽  
Maternal Blood ◽  
Labor Analgesia ◽  
Nausea And Vomiting ◽  
Injection Pain ◽  
Pain Scores ◽  
Sole Agent ◽  
Spinal Epidural

Background This study determined the dose-response relation of intrathecal fentanyl for labor analgesia and described the onset, duration, and quality of analgesia when used as the sole analgesic. Methods Eighty-four parturients in active labor who requested analgesia were randomized to one of seven treatment groups. They received 5-45 microg intrathecal fentanyl as part of a combined spinal-epidural technique. Visual analog pain scores were recorded before and at intervals after injection patients requested additional analgesia. The occurrence and severity of pruritus, nausea, and vomiting were also recorded. Maternal blood pressure was recorded before injection and at intervals after injection. Fetal heart rate was recorded before and 30 min after injection. Results By 5 min after injection, pain scores were significantly different among groups (P < 0.001). Mean duration of analgesia increased to 89 min as the dose increased to 25 microg. Maternal diastolic blood pressure was significantly lower 10 and 30 min after injection. There was no difference among groups in the incidence of pruritus; nausea and vomiting were uncommon. Fetal heart rates did not change after injection. A dose-response curve indicates that the median effective dose of intrathecal fentanyl for labor analgesia is 14 microg (95% confidence interval, 13-15 microg). Conclusions Intrathecal fentanyl produces rapid, profound labor analgesia with minimal side effects. These data indicate that there is little benefit to increasing the dose beyond 25 microg when it is used as the sole agent for intrathecal labor analgesia.

Intrathecal Neostigmine and Sufentanil for Early Labor Analgesia 

1999 ◽  
Vol 91 (5) ◽  
pp. 1293-1293 ◽  
Author(s):  
Kenneth E. Nelson ◽  
Robert D'Angelo ◽  
Michael L. Foss ◽  
Greg C. Meister ◽  
David D. Hood ◽  
...  
Keyword(s):  
Side Effects ◽  
Vital Signs ◽  
Lateral Position ◽  
Labor Analgesia ◽  
Phase Iii ◽  
Fixed Dose ◽  
Open Label ◽  
Severe Nausea ◽  
Label Dose ◽  
Spinal Epidural

Background Recent efforts to improve the combined spinal epidural (CSE) technique have focused on adding opioids to other classes of analgesics. In this study, the authors used intrathecal neostigmine in combination with intrathecal sufentanil to investigate the usefulness of neostigmine for reducing side effects and prolonging the duration of sufentanil. Methods One hundred six healthy pregnant women in labor were enrolled in this study, which was divided into four phases. In all phases, patients received a CSE anesthetic while in the lateral position. In phase I, three groups of six women each received intrathecal neostigmine, 5, 10, or 20 microg, in an open-label, dose-escalating safety assessment. In phase II, 24 women received intrathecal sufentanil alone to establish an ED50 (dose that produces > 60 min of labor analgesia in 50% of patients). In phase III, an ED50 was established for sufentanil combined with a fixed dose of neostigmine (10 microg). In phase IV, 40 women received either twice the ED50 of sufentanil alone or twice the ED50 of sufentanil plus neostigmine, 10 microg. Results Neostigmine alone had no adverse effects on maternal vital signs, fetal heart rate, or Apgar scores. Neostigmine, 20 microg, produced analgesia in one patient and severe nausea and vomiting in another. The ED50 for intrathecal sufentanil alone was 4.1 +/- 0.31 microg, and the ED50 for intrathecal sufentanil combined with neostigmine, 10 microg, was 3.0 +/- 0.28 microg. The duration of analgesia and side effects from double these ED50s (sufentanil, 9 microg, or sufentanil, 6 microg, plus neostigmine, 10 microg) were similar between groups. Conclusions The 10-microg intrathecal neostigmine dose alone produced no analgesia or side effects, but reduced the ED50 of intrathecal sufentanil by approximately 25%. Additionally, doses approximately double these ED50s each produced a similar duration of analgesia and side effects, indicating intrathecal neostigmine shifts the dose-response curve for intrathecal sufentanil to the left.

Epidural Fentanyl Produces Labor Analgesia by a Spinal Mechanism 

1998 ◽  
Vol 88 (6) ◽  
pp. 1519-1523 ◽  
Author(s):  
Robert D'Angelo ◽  
J. C. Gerancher ◽  
James C. Eisenach ◽  
Brenda L. Raphael
Keyword(s):  
Side Effects ◽  
Low Dose ◽  
Labor Analgesia ◽  
Epidural Fentanyl ◽  
Saline Control ◽  
Intravenous Fentanyl ◽  
Epidural Bupivacaine ◽  
Spinal Mechanism ◽  
Intravenous Saline ◽  
To Receive

Background The purpose of this study was to determine if epidural fentanyl produces analgesia in laboring patients by a primary spinal or supraspinal action. Methods Fifty-four parturients were randomized to receive epidural 0.125% bupivacaine plus one of three treatments: epidural saline-intravenous saline, epidural fentanyl (20 microg/h)-intravenous saline, or epidural saline-intravenous fentanyl (20 microg/h). The study treatments were administered by continuous infusion, whereas epidural bupivacaine use was patient controlled. Results Epidural bupivacaine use was significantly reduced by epidural (11.5+/-4.6 ml/h) but not by intravenous fentanyl (15.9+/-4.5 ml/h) compared with saline control (16+/-5.9 ml/ h). Analgesia characteristics and side effects were similar among groups. Conclusions Low-dose epidural infusions of fentanyl produce labor analgesia by a primary spinal action.

Fetal Heart Rate and Uterine Contraction Pattern Abnormalities after Combined Spinal/Epidural vs. Systemic Labor Analgesia

2002 ◽  
Vol 96 (Sup 2) ◽  
pp. A1049
Author(s):  
Barbara M. Scavone ◽  
John T. Sullivan ◽  
Alan M. Peaceman ◽  
Tina P. Strauss-Hoder ◽  
Cynthia A. Wong
Keyword(s):  
Heart Rate ◽  
Fetal Heart Rate ◽  
Uterine Contraction ◽  
Fetal Heart ◽  
Labor Analgesia ◽  
Contraction Pattern ◽  
Combined Spinal Epidural ◽  
Spinal Epidural

Optimal Anesthesia Scheme for Transfer to Emergency Cesarean Section in Failed Labor Analgesia Trial Delivery

2021 ◽  
Author(s):  
Wen-hao Bu ◽  
Wei Wu ◽  
Na Li ◽  
Lin Chen ◽  
Lin-li Yue
Keyword(s):  
Cesarean Section ◽  
Epidural Anesthesia ◽  
Vital Signs ◽  
Labor Analgesia ◽  
Emergency Cesarean Section ◽  
Combined Spinal Epidural ◽  
Emergency Cesarean ◽  
The Difference ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural

Abstract Objective： To explore the optimal anesthetic method of transferring to emergency cesarean section after the failure of labor analgesia. Methods: A retrospective study included 1154 patients who underwent cesarean section in Hubei Maternal and Child Health Hospital from January 2019 to January 2020, of which 586 patients were transferred to cesarean section after labor analgesia, They were divided into two groups according to the method of anesthesia: Epidural labor analgesia / Epidural anesthesia (ELA/EA) group : After the failure of natural labor during labor analgesia, local anesthetics continue to be added to the epidural(n=282);Epidural labor analgesia/Combined spinal and epidural anesthesia(ELA/CSEA) group: Combined spinal-epidural anesthesia was performed after spontaneous labor failure during epidural labor analgesia(n=304); Combined spinal and epidural anesthesia(CSEA) group: Patients who undergo emergency cesarean section without labor analgesia(n=568). The case data were reviewed and the anesthetic methods, basic vital signs, medication, time, maternal and infant outcome of the three groups were descriptively analyzed. Results: There was a difference in the time of admission to neonatal delivery, the maximum decrease of diastolic blood pressure and the difference of neonatal 1min apgar score between ELA/EA group and ELA/CSEA group. There was a difference in the dosage of spinal anesthesia between ELA/CSEA group and CSEA group. Conclusion: When the obstetrician anesthesiologist fails during labor analgesia and needs to be transferred to cesarean section, they can choose to re-perform combined spinal-epidural anesthesia, which is beneficial to the early outcome of newborns, but the long-term effect on newborns needs to be further studied.

Effects of perioperative S (+) ketamine infusion added to multimodal analgesia in patients undergoing ambulatory haemorrhoidectomy

2010 ◽  
Vol 1 (2) ◽  
pp. 100-105 ◽  
Author(s):  
Ulrich J. Spreng ◽  
Vegard Dahl ◽  
Johan Ræder
Keyword(s):  
Side Effects ◽  
Postoperative Analgesia ◽  
Analgesic Effect ◽  
Low Dose ◽  
Isotonic Saline ◽  
Multimodal Analgesia ◽  
Controlled Study ◽  
Double Blind ◽  
Pain Scores ◽  
Pacu Stay

AbstractBackground and objectivePerioperative low-dose ketamine has been useful for postoperative analgesia. In this study we wanted to assess the analgesic effect and possible side-effects of perioperative low-dose S (+) ketamine when added to a regime of non-opioid multimodal pain prophylaxis.MethodsSeventy-seven patients scheduled for haemorrhoidectomy were enrolled in this randomized, double-blind, controlled study. They received oral paracetamol 1–2 g, total intravenous anaesthesia, intravenous 8 mg dexamethasone, 30 mg ketorolac and local infiltration with bupivacaine/epinephrine. Patients randomized to S (+) ketamine received an intravenous bolus dose of 0.35 mg kg−1 S (+) ketamine before start of surgery followed by continuous infusion of 5 μg kg−1 min−1 until 2 min after end of surgery. Patients in the placebo group got isotonic saline (bolus and infusion). BISTM monitoring was used. Pain intensity and side-effects were assessed by blinded nursing staff during PACU stay and by phone 1, 7 and 90 days after surgery.ResultsIn patients randomized to S (+) ketamine emergence from anaesthesia was significantly longer (13.1 min vs. 9.3 min; p < 0.001). BIS values were significantly higher during anaesthesia (maximal value during surgery: 62 vs. 57; p = 0.01) and when opening eyes (81 vs. 70, p < 0.001). Pain scores (NRS and VAS) did not differ significantly between groups.ConclusionsThe addition of perioperative S (+) ketamine for postoperative analgesia after haemorrhoidectomy on top of multimodal non-opioid pain prophylaxis does not seem to be warranted, due to delayed emergence and recovery, more side-effects, altered BIS readings and absence of additive analgesic effect.

Bupivacaine Augments Intrathecal Fentanyl for Labor Analgesia 

1999 ◽  
Vol 91 (1) ◽  
pp. 84-89 ◽  
Author(s):  
Craig M. Palmer ◽  
Gretchen Van Maren ◽  
Wallace M. Nogami ◽  
Diane Alves
Keyword(s):  
Blood Pressure ◽  
Muscle Strength ◽  
Fetal Heart ◽  
Intrathecal Injection ◽  
Maternal Blood ◽  
Labor Analgesia ◽  
Regional Analgesia ◽  
Lower Extremity Muscle ◽  
Spinal Epidural ◽  
Maternal Blood Pressure

Background fentanyl has been shown to be an effective analgesic for labor; this study investigated the analgesic effect of low-dose bpivacaine added to intrathecal fentanyl for labor analgesia Methods Ninety parturients in active labor who requested regional analgesia were randomized to receive an intrathecal injection of either fentanyl, 25 microg; bupivacaine, 1.25 mg, with fentanyl, 25 microg; or bupivacaine, 2.5 mg, with fentanyl, 25 microg, as part of a combined spinal-epidural technique. Visual analog pain scores were recorded before and at intervals after injection until the patient requested further analgesia. Maternal blood pressure and fetal heart rate were recorded before and at intervals after injection. Lower-extremity muscle strength was tested before and 30 min after injection; anesthetic level to cold sensation and the presence and severity of pruritus were recorded. Results Duration of analgesia was longer in the group receiving bupivacaine, 2.5 mg, and fentanyl, 25 microg, than the group receiving plain fentanyl (108 vs. 92 min; P &lt; 0.05). Onset of analgesia was faster in both groups receiving bupivacaine compared with plain fentanyl (P &lt; 0.05). No differences in muscle strength after injection were found in any group, although anesthetic levels to cold were documented in all patients in the bupivacaine groups, and 21 of 30 in the plain fentanyl group. Baseline fetal heart rates did not change after injection in any group, and maternal blood pressure was unchanged. Conclusions The addition of 2.5 mg isobaric bupivacaine to 25 microg fentanyl for intrathecal labor analgesia modestly increases duration and speeds onset of analgesia compared with plain intrathecal fentanyl.

452 The effects of low-dose epidural technique for labor analgesia on fetal heart rate (FHR)

2001 ◽  
Vol 185 (6) ◽  
pp. S206 ◽  
Author(s):  
James Hill ◽  
James M. Alexander ◽  
Shiv K. Sharma ◽  
Donald D. McIntire ◽  
Kenneth J. Leveno
Keyword(s):  
Heart Rate ◽  
Fetal Heart Rate ◽  
Low Dose ◽  
Fetal Heart ◽  
Labor Analgesia

Minimum Local Analgesic Doses of Ropivacaine, Levobupivacaine, and Bupivacaine for Intrathecal Labor Analgesia

2005 ◽  
Vol 102 (3) ◽  
pp. 646-650 ◽  
Author(s):  
Michela Camorcia ◽  
Giorgio Capogna ◽  
Malachy O. Columb
Keyword(s):  
Local Anesthetic ◽  
Labor Analgesia ◽  
Allocation Model ◽  
Analgesic Dose ◽  
Sequential Allocation ◽  
Visual Analog Pain Score ◽  
Spinal Epidural ◽  
To Receive ◽  
Local Anesthetic Drug ◽  
Analgesic Potency

Background Doses for intrathecal opioid-local anesthetic mixtures have been arbitrarily chosen. The aim of this study was to compare the analgesic efficacies of intrathecal ropivacaine, levobupivacaine, and bupivacaine for labor analgesia and to determine the analgesic potency ratios for these three drugs. For this purpose, the authors used the up-down sequential allocation model, which estimates the minimum local analgesic dose for intrathecal local anesthetic. Methods Ninety-seven nulliparous term parturients in spontaneous labor, requesting combined spinal-epidural analgesia, were randomly allocated to one of three groups to receive 0.25% spinal ropivacaine, levobupivacaine, or bupivacaine. The initial dose of the local anesthetic drug was chosen to be 2.5 mg, and the testing interval was set at 0.25 mg. The subsequent doses were determined by the response of the previous parturient. Efficacy was accepted if the visual analog pain score decreased to 10 mm or less on a 100-mm scale within 30 min. The minimum local analgesic dose was calculated using the method of Dixon and Massey. Results The intrathecal minimum local analgesic dose was 3.64 mg (95% confidence interval, 3.33-3.96 mg) for ropivacaine, 2.94 (2.73-3.16) mg for levobupivacaine, and 2.37 (2.17-2.58) mg for bupivacaine. The relative analgesic potency ratios were 0.65 (0.56-0.76) for ropivacaine:bupivacaine, 0.80 (0.70-0.92) for ropivacaine:levobupivacaine, and 0.81 (0.69-0.94) for levobupivacaine:bupivacaine. There were significant trends (P &lt;/= 0.021) for greater motor block with bupivacaine and levobupivacaine. Conclusions This study suggests a potency hierarchy of spinal bupivacaine &gt; levobupivacaine &gt; ropivacaine.

scholarly journals Efficacy of Addition of Fentanyl to Epidural Bupivacaine on Postoperative Analgesia after Thoracotomy for Lung Resection in Infants

2008 ◽  
Vol 109 (5) ◽  
pp. 890-894 ◽  
Author(s):  
Arjunan Ganesh ◽  
N Scott Adzick ◽  
Travis Foster ◽  
Giovanni Cucchiaro
Keyword(s):  
Side Effects ◽  
Lung Resection ◽  
Epidural Fentanyl ◽  
Double Blind Study ◽  
Double Blind ◽  
Rescue Dose ◽  
Pain Scores ◽  
Epidural Bupivacaine ◽  
Group B ◽  
To Receive

Background The authors evaluated the efficacy of adding fentanyl to epidural bupivacaine in infants up to 6 months of age after a thoracotomy in a prospective, randomized, double-blind study. The primary outcome was the total amount of rescue doses of intravenous nalbuphine in the first 24 h after surgery. Secondary outcomes included (1) time to first rescue dose of nalbuphine, (2) pain scores, and (3) behavior scores. Methods Thirty-two infants were randomly assigned to receive an epidural infusion containing 0.1% bupivacaine (group B; n = 16) or 0.1% bupivacaine and 2 microg/ml fentanyl (group BF; n = 16). Patients were evaluated up to 24 h after surgery for pain; amount of analgesic rescues and time to first rescue; pain scores; behavior scores (five-item behavior score); and complications, including respiratory depression, oxygen requirement, vomiting, and urinary retention. Results The two groups had similar demographics. Nalbuphine consumption (P = 0.001) and pain scores (P &lt; 0.001) in the first 24 h were significantly decreased in group BF compared with group B. The time to first analgesic rescue was significantly longer in group BF (P = 0.005). The five-item behavior score was significantly better in group BF than in group B (P = 0.01). The incidence of side effects, the time to first successful feeding, and the time to discharge were similar in both groups. Conclusions Addition of 2 microg/ml epidural fentanyl to 0.1% bupivacaine results in improved postthoracotomy analgesia without any increase in side effects, compared with 0.1% bupivacaine, in infants up to 6 months of age.

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